低剂量CT灌注扫描定量评估近侧胃癌可行性的初步研究  

Feasibility of low dose computed tomography perfusion imaging in quantitative evaluating proximal gastric cancer: a pilot study

作　　者：杨岚清[1] 余鑫[1] 张菁[1] 李真林[1] 夏春潮[1] 帅桃[1] 伍兵[1] 

机构地区：[1]四川大学华西医院放射科,成都610041

出　　处：《中国普外基础与临床杂志》2017年第8期1014-1020,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技厅科技支撑项目(项目编号:2014SZ0150)

摘　　要：目的探究低剂量CT灌注扫描定量评估近侧胃癌的可行性及临床价值。方法前瞻性纳入笔者所在医院2015年9月至2016年2月期间初步诊断为近侧胃癌患者(近侧胃癌组),并选取纳入患者中胃底部分没有受累者作为对照(正常胃底组)。计算每次扫描的有效辐射剂量,使用后处理软件生成灌注参数图,包括达峰时间(TTP)、血流量(BF)、血容量(BV)、平均通过时间(MTT)和毛细血管渗透性(PMB),比较近侧胃癌组和正常胃底组各灌注参数值的差异并绘制受试者工作特征(ROC)曲线。结果本研究近侧胃癌组最终纳入符合条件的患者34例,正常胃底组25例。34例近侧胃癌患者中T1+T2期11例,T3+T4期23例;腺癌26例,印戒细胞癌8例;无淋巴结转移17例,有淋巴结转移17例。(1)近侧胃癌组的BF、BV及PMB值均明显高于正常胃底组(P<0.001),但MTT及TTP值低于正常胃底组(P=0.050,P=0.036)。BF、BV、PMB、MTT及TTP诊断近侧胃癌的ROC曲线下面积分别为0.955、0.807、0.987、0.654及0.649,BF和PMB诊断近侧胃癌的能力最强,其次为BV。(2)印戒细胞癌的BF值明显低于腺癌(P<0.001),而其PMB值明显高于腺癌(P<0.001)。印戒细胞癌和腺癌的BV、MTT和TTP值比较差异均无统计学意义(P>0.05)。BF和PMB鉴别组织病理类型的ROC曲线下面积分别为0.986和0.856,BF对患者的组织病理类型诊断能力强于PMB(P=0.047)。(3)T3+T4期患者的PMB值大于T1+T2期患者(P=0.004),而BF、BV、MTT及TTP值在T3+T4期和T1+T2期患者间比较差异均无统计学意义(P>0.05)。PMB区分T分期的ROC曲线下面积为0.814。(4)有淋巴结转移患者与无淋巴结转移患者的各灌注参数间比较差异均无统计学意义(P>0.05)。(5)受试者在单次CT灌注成像中所接受的有效辐射剂量为8.58 m Sv,远低于常规CT灌注检查辐射剂量标准。(6)不同组织病理类型的近侧胃癌患者的淋巴结转移率和高T分期率比较差异亦均无统计学意义(P>0.05)。结论低剂Objective To explore feasibility and clinical value of low dose computed tomography perfusion imaging （CTPI） in quantitative assessing proximal gastric cancer. Methods A total of 34 patients diagnosed with proximal gastric cancer （a proximal gastric cancer group） were enrolled prospectively in this study. The 25 normal parts of gastric fundus of the included patients constituted a control group. All the patients underwent the low dose CTPI before surgery. The total effective radiation dose was recorded, and a specific post-processing software was used to automatically generate the perfusion parameters values, including the time to peak （TTP）, blood flow （BF）, blood volume （BV）, mean transmit time （MTT）, and permeability （PMB）. The perfusion parameters in the different histopathologic types and stages of the patients were compared. Receiver operating characteristic （ROC） curves were generated to compare their diagnosis performances. Results The histopathologic findings verified that there were 11 patients with T I＋T2 stage and 23 patients with T3＋T4 stage; 8 patients with signet ring cell carcinoma and 26 patients with adenocarcmoma; and 17 patients with lymphatic metastasis and 17 patients without lymphatic metastasis. ① Compared with the control group, the BF, BV, and PMB values were significantly higher and the MTT and TTP values were significantly lower in the proximal gastric cancer group. The area under the ROC curve （AUC） values of the BF, BV, PMB, MTT, and TTP in the diagnosing proximal gastric cancer was 0.955, 0.807, 0.987, 0.654, and 0.649 respectively. The BF and PMB represented the best diagnostic performances, and the BV was secondary in the ROC curve results. ② The BF value was significantly lower and the PMB value was significantly higher in the patients with signet ring cell carcinoma as compared with the patients with adenocarcinoma. However, the BV, MTT, and TTP values had no significant differences in both them. And the BF （A UC=0.986） had a bette

关 键 词：CT灌注成像 低剂量 近侧胃癌 

分 类 号：R730.44[医药卫生—肿瘤] R735.2[医药卫生—临床医学]